D0642 - Subclinical Celiac Disease in the U.S. Hispanic Population: Results From the Los Angeles County Department of Health Services

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Stephanie Pintas, BA

David Geffen School of Medicine at UCLA
Los Angeles, CA

Stephanie Pintas, BA¹, Guy A. Weiss, MD², Jason Yang, MD¹, Wayne Fleischman, MD³
¹David Geffen School of Medicine at UCLA, Los Angeles, CA; ²University of California Los Angeles, Los Angeles, CA; ³UCLA Medical Center-Olive View, Sylmar, CA

Introduction: Anemia is a common extraintestinal manifestation of celiac disease (CeD). Although perceived as a predominantly Caucasian disease with a 1% prevalence, CeD also affects other underreported populations, such as the Hispanic population. We aimed to estimate the prevalence of CeD in Hispanic patients presenting with unexplained anemia.

Methods: A cross-sectional study was completed through a clinical management database and electronic medical record after receiving Institution Review Board approval. Adult Hispanic patients with unexplained anemia who underwent upper endoscopy with duodenal biopsies between 2013 and 2020, were included. This study was conducted at the Los Angeles County Department of Health Services, a safety-net public health care system with a predominantly Hispanic (65%) population. Electronic medical records were queried for the diagnosis of biopsy-proven CeD.

Results: 206 subjects underwent upper endoscopy for unexplained anemia, of which 61 were excluded (18 underwent an upper endoscopy without biopsy, 7 were non-Hispanic, and 36 patients had normal hemoglobin levels). Among all Hispanic patients referred for endoscopic evaluation of unexplained anemia (N = 145), the mean age was 53.9 years, and 66% were female. The overall prevalence of biopsy-proven CeD was 4.8% (N = 7/145). In patients with iron-deficiency anemia (IDA) specifically, the prevalence of CeD was 4.5% (N = 3/67). Of the 7 patients with confirmed CeD, only one in retrospect had associated diarrhea. None of the patients had a family history of CeD. Interestingly, only one of five tested patients had positive IgA tissue transglutaminase antibody, and the remainder were seronegative. Other CeD-related laboratory testing including vitamin B12 and liver function tests were unremarkable; thyroid stimulating hormone (TSH) levels were within normal range except for one patient with elevated levels due to poorly controlled hypothyroidism.

Discussion: The prevalence of CeD in adult Hispanic patients with unexplained anemia (unspecified or IDA) is similar to the prevalence in Caucasian patients, a finding not previously reported in the literature. Screening for CeD in patients with unexplained anemia in general, and IDA specifically, is of value in Hispanic patients as well as Caucasian ones. Seronegative CeD requires endoscopic evaluation with duodenal biopsies for diagnosis.

ID	Hemoglobin (Ferritin)	AST/ALT	Total Bilirubin	IgA tTG	Vitamin B12	TSH	Other Comorbidities
49 F	8.5	33/17	0.5	None	652	12.8	Hypothyroidism, Rheumatoid arthritis on sulfasalazine and methotrexate
42 F	11.6 (70.7)	None	None	< 1	596	None	Refractory GERD s/p fundoplication
57 F	8.4 (7.6)	42/51	0.6	>100	NA	None	Hypothyroidism, Chronic hepatitis C
34 F	11.7	16/12	0.6	< 1	325	None	None
40 M	10.7	29/40	0.6	None	481	0.83	Substance abuse, Coronary artery disease with NSTEMI, Osteoporosis
50 F	9.9 (5.4)	22/23	0.5	< 1	291	2.1	Stage II breast cancer
44 F	9.5 (3.1)	29/33	0.6	< 1	NA	1	Type II diabetes

Table: Table 2. Clinical and Lab Characteristics of Patients with Biopsy-Confirmed Celiac Disease
tTG: IgA tissue transglutaminase within <4 months from index endoscopy; TSH: thyroid stimulating hormone; M: male; F: female; AST: aspartate aminotransferase; ALT: alanine transaminase

Disclosures:

Stephanie Pintas indicated no relevant financial relationships.

Guy Weiss: EverlyHealth – Advisory Committee/Board Member.

Jason Yang indicated no relevant financial relationships.

Wayne Fleischman indicated no relevant financial relationships.

Stephanie Pintas, BA¹, Guy A. Weiss, MD², Jason Yang, MD¹, Wayne Fleischman, MD³. D0642 - Subclinical Celiac Disease in the U.S. Hispanic Population: Results From the Los Angeles County Department of Health Services, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.